A small but growing number of prominent, Republican governors — including Mitch Daniels and Haley Barbour — are taking the lead to shape a key component of the health care overhaul their party fought so hard to kill.

It’s a delicate balancing act for Republicans who, on the one hand, oppose federal health reform, even challenging its constitutionality in federal court, and, on the other hand, are pragmatically trying to control as much of the implementation process as they can.

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POLITICO 44

In Indiana, Gov. Mitch Daniels issued an executive order that allowed the state to become one of just three to receive a multimillion dollar grant to establish a health exchange, the online insurance marketplaces that all states must eventually have if the reform law stands up in court.

Wisconsin, under the leadership of Gov. Scott Walker, is one of six states to win an Early Innovator grant. While the grant was received under Walker’s predecessor, Gov. Jim Doyle, Walker has continued to use the resource, setting up the Office of Free Market Health Care that has prominently advertised its innovator status.

And in a weird twist of politics in Mississippi, state agencies of Gov. Haley Barbour have relied on little-used statutory authorities to set up an exchange, reviving a Democratic-sponsored effort to do so through the Mississippi State Legislature.

Daniels, Walker and Barbour are a stark contrast to Republican governors who are more stridently opposed to all aspects of health reform. Govs. Rick Scott of Florida, Bobby Jindal of Louisiana, and Susana Martinez of New Mexico have come out in fierce opposition of any kind of implementation.

Scott and Jindal have also shunned federal money to plan their exchanges.

“The Rick Scotts of the world are probably going to be in the minority,” says one Republican health policy source, referring to the Florida governor’s halting health reform implementation. “The ones that block it fundamentally have a disagreement or it fits into a broader political calculus.”

Many strategists in D.C. contend that setting up the exchanges undermines Republicans’ constitutional challenges to the health reform law.

But having a handful of prominent Republican governors move forward on the issue — two of whom weighed presidential runs — suggests that the exchanges could emerge as one of the more palatable provisions of the contentious law.

And still other Republican governors, with smaller national profiles, have also endorsed implementing state-run health exchanges.They include Nevada’s Brian Sandoval, who is backing an exchange implementation bill in the Nevada State Legislature, Georgia’s Nathan Deal and Virginia’s Bob McDonnell.

“The big picture is that, while there’s an ideological divide, many governors see the exchange as an empty vessel they can shape in their own image,” says Ian Morrison, an independent health policy consultant in California. “Republican governors like the idea of more commercial insurance.”

Another crucial factor at play: If states don’t set up their own exchanges by 2014, the federal government will come in and do it for them.

Individual Mandate was/is Republican idea for decades until Obama embraced it. Where is the public option? Oh yeah! GOP pretend not to like it, but when we are not looking they high fives one another because of personal responsibility called Individual Mandate. I would like to see a DEM's idea not this one.

The bottom line is - If the states had - years, and years, and years ago - stepped up and done what was right for their states - If Governors had years, and years, and years ago, done what they were supposed to - The President would not have had to pass a law to help the many desperate Americans who were getting no help at all, and who had got no action at all, for decades from their State Governors.

So - Finally - NOW, most Democrat Goverors, and some Republican Governors - are realizing that this Healthcare law is a good thing, and that is it about helping the citizens of the country - and therefore the citizens of their states as well.

This is NOT about ideology - it's about finding a solution to a problem - and then getting things done !

We cannot afford Obamacare. It's costs are huge, far more than previously claimed. Obamacare's costs will sink this country, just as Medicare's costs threaten to.

Rather than reform spending, all Democrats can do is continue to spend, hugely and enormously, on Obamacare, on Medicare, on Medicaid, on doubling and tripling the budgets of most domestic agencies. It's no problem, they say. We can keep this outrageous spending up, without going bankrupt or causing harm to the economy or the currency, according to the Democrats. They want no reform, no cutting waste, no shrinking of huge government programs. Just spend, spend, spend, and raise taxes. And when someone tries to be fiscally responsible, they attack the living daylights out of that person.

The Democrat policies are leading to a fiscal apocalypse. They will not stop spending and taxing, or attacking anyone who wants to fix the finances and bloated government of this country.

If taxes go up to pay for all these reckless Democrat policies, people will simply throw up their hands and go John Galt, just as those that left New York City did when Bloomberg raised their taxes. If Republicans cannot hold the line on this, they will disappear as a party, and another will spring up.

Good for them. The Teahadist/Bagger movement will not like this at all. Lest we forget the Individual Mandate was a GOP idea.

Funny how every single person is required to have car insurance, yet you don't see the GOP/Tea Party protesting it as a forced expense and an overreach of government, but when the government decides its a good idea to protect the health of its citizens, they go go nuts.

Not everyone drives a car, yet we have a Individual Mandate for Car Insurance

EVREYONE has a body, yet an individual mandate to buy Health Insurance is an overreach.

if mandates are such an extreme overreach, then logically it follows that the GOP/TP would oppose the Car Insurance one, too. But hey, since when were facts or logic a deciding factor for anything these morons do or say?

You are aware that ObamaCare would REDUCE the federal deficit by more than a TRILLION over ten years right? The porjected costs for that program are far smaller than the costs the govt would incur without the program. Get your facts straight.

Ahh God bless the free market. I used to blame the free market for not adequately servicing the 47 million people without health insurance. Then Rush patiently explained to me that 46,999,999 of them were illegals and the other one was named Hector Hernandez. Thus the health care crisis was ginned up by the Democrat party and their trial lawyer and union pals. Shock shock! Go Scott, Mitch and Haley!

These Governors are doing the right thing by moving forward. Even those totally opposed to the ACA have to admit there are some good things in there that will help people. Instead of fighting this fight all over again it would be wise to implement and improve it.

What precisely is a health care exchange? Does this mean that all health insurance companies will now be permitted to sell insurance in every State and actually compete for business, as is stated in the Ryan plan? With all of the name-calling, mud-slinging and other nonsense, I have yet to see a definition of a health care exchange? What is it and how will it work?

As usual, I'm sure no one will answer that question because as Ms. Pelosi famously said 'We have to pass the Bill to find out what's in it.'

As for the misguided individuals who keep equating health insurance with auto insurance, rest assured that there are a great many licensed drivers on the road who carry no auto insurance. If the vehicle is financed, the lender mandates that insurance coverage be maintained to collateralize the loan, but if the vehicle is owned free and clear, many do not purchase insurance. I've lived in the downtown areas of Philadelphia, Chicago and Cleveland, and I can say that illegals and almost all non-working blacks do not carry auto insurance while riding around aimlessly. Here in So. Fl. it's the same with the addition of Hatians and Guatemalans. The illegals often can't provide proof of ownership or citizenship (unless they have false documents, but they're expensive), and the non-working blacks simply don't give a damn.

So, dear libs, there is no correlation between health insurance and auto insurance. Back to the drawing board with you. Do better next time.

The exchange was the only part of the ACA that was free-market friendly. It's not surprising that the governors who come from the most free-market states (not the same as Republican), would be the first to embrace them.

It's telling that so many politically interested people still don't understand even the most basic beliefs after all this time.

Maybe their work will lead to the necessary next step: definitions of how far treatments will go when paid with taxpayer money -- WITHOUT the blathering of Palin or the teabaggers about "death panels." For years we've had insurance companies making decisions on who gets what treatment at how far treatment goes, quietly shading themselves from the political fray, and underwriting extensive treatment for SOME as long as they make their profits. Ultimately there will have to be much clearer lines about how far treatment goes but it's still political hellfire to admit it.

If these governors start work under the law, great - but it will lead to those conversations. One way or the other I agree with the others who (correctly) recognize that the overall goverment costs will go down as the law is implemented, because we now underwrite the uninsured at taxpayer expense.

On the Huge cost of Health Care to the States. Where does it come from? Everyone knows. No one talks about it. The Republican Goxs...controlled by the Right Wing Extremists who know................don't say anything because the RICH like it the way it is...

FACT.(foxnews..Loudobbs) The state Of Florida spends......SIX AND A HALF BILLION DOLLARS PROVIDING MEDICADE AND FOOD STAMPS TO THE FAMILIES OF ILLEGAL FOREIGN NATIONALS LIVING AND WORKING IN FLORIDA. CALIFORNIA SPENDS 22 BILLION A YEAR DOING THE SAME.

NO ONE CONTRIDICTS THAT..NOT ANYONE HONEST. THE STATISTICS ARE FROM STATE DATA. THEY ARE ALSO AT THE CENTER FOR IMMIGRATION STUDIES..ALONG WITH THE FOLLOWING INFORMATION:

57% OF LEGAL IMMIGRANTS ARE ON TWO FORMS OF WELFARE..FOOD STAMPS AND MEDICADE. OVER 100 MILLION LEGAL IMMIGRANTS HAVE ENTERED THE USA IN THE LAST 28 YEARS. SOURCE..USA STATISTICS. 147,000 FOREIGN WORKERS WILL BE BROUGHT OVER THIS MONTH......BECAUSE BUSINESS LIKES CHEAP, EASILY CONTROLLED WORKERS.

81% OF FAMILIES HEADED BY A FOREIGN NATIONAL ILLEGALLY WORKING IN THE USA......ARE ON FOOD STAMPS AND MEDICADE.

MEDICADE HAS DOUBLE IN THE LAST TWO YEARS.........IT HAS GROWN 56% SINCE OBAMA WAS PRESIDENT.

SO...REPUBLICANS. KILL MEDICARE. THEN SOCIALSECURITY.

DEMOCRATS.........LET ANOTHER 20 MILLION IN.....OR RATHER THEY ARE DOING THAT NOW BY KEEPING THE BORDERS OPEN......NO WORKPLACE ENFORCEMENT.....LYING ABOUT DEPORATION RATES.....

SOOOOOOOOOOO WHAT IS THE POINT OF THIS? NONE OF THEM INTEND TO DO DOODLEY SQUAT ABOUT THE REAL CANCER ON HEALTH CARE IN THE USA.........AND NEITHER IS GOING TO STOP ILLEGAL LABOR OR CHEAP FOREIGN LABOR FROM FLOODING INTO THE USA.BECAUSE THE RICH LIKE IT.

The establishment Republicans have no intention of stopping Obamacare. They are selling out the people just like the COMMUNIST DEMOCRATS. The establishment Republicans are going to go after any candidate that bucks them. Karl Rove was on Fox today bad mouthing Sarah Palin. She will not conform to their rules, nor the Bilderburg Group rules. The people in Washington could care less about the American people. We must clean it out to take back our country.

Conservfail, in other words, you add 30 million people to the rolls, and it costs less money. I want what you're smoking!

So, you add on big government programs, triple spending, and it SAVES you money. Funny, my husband never goes for that one when the credit card bill comes. I keep saying, the more I spend, the more I save! But does he listen? No. Sigh.

Maybe these governors are starting to realize that the constitutional challenges to the Affordable Care Act and the threats of repeal are a complete joke. They might as well comply with the law since it is never going to get overturned.

A more interesting point would be if they can reverse the effects of competition-killing laws like McCarran Ferguson and ERISA preemption. Giving people a list of companies without any variation in them, such as high-deductible HCA to low-deductible, or restricted (i.e. no ultra-expensive drugs when lower cost ones are available) policies, still won't be that useful. It might give more people an idea of just how controlled the market is, but outrage doesn't seem to do much good if the old political parties don't care.

Surprise, surprise, the Republicans have no shame. Feast your eyes on the glorious sight of these blowhards throwing tantrums about the illegality of the idea they came up with, and in the same breath, taking advantage of it. How shocking, and here I thought the Republicans were principled!?

If I had to depend on Obambi and Sebellius to set up a program for my State, I would set it up myself as well. Besides, this part of the reform goes along with the Ryan plan as well. It's the amount of funding and the type of required coverage that are the problems.

So if we can get rid of the spenders currently in DC, the States will be able to use the framework to devise something that is affordable and will not bankrupt the country.